修薄的股前外侧穿支皮瓣联合分指及指蹼成形术序贯治疗全手脱套毁损性创面的效果  

Effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand

作　　者：尹善青[1] 竺枫[1] 黄耀鹏[1] 潘佳栋[1] 肖栋超 刘林海[1] 李学渊[1] 王欣[1] Yin Shanqing;Zhu Feng;Huang Yaopeng;Pan Jiadong;Xiao Dongchao;Liu Linhai;Li Xueyuan;Wang Xin(Department of Hand Surgery,Ningbo No.6 Hospital,Ningbo315000,China)

机构地区：[1]宁波市第六医院手外科,宁波315000

出　　处：《中华烧伤与创面修复杂志》2024年第11期1052-1058,共7页Chinese Journal of Burns And Wounds

基　　金：宁波市医疗卫生高端团队重大攻坚项目(2022020506);宁波市重点研发计划(2022Z146);宁波市科技计划项目(2018A610258)。

摘　　要：目的探讨采用修薄的股前外侧穿支皮瓣联合分指及指蹼成形术序贯治疗全手脱套毁损性创面的效果。方法该研究为回顾性观察性研究。2012年1月—2023年1月,宁波市第六医院收治15例符合入选标准的全手脱套毁损性创面患者,其中男10例、女5例,年龄17~75岁,创面均合并骨骼或肌腱外露。Ⅰ期皮瓣移植术前均急诊行清创+负压封闭引流处理,彻底清创后,创面面积为11.0 cm×3.0 cm~23.0 cm×13.5 cm。设计并切取一侧或双侧股前外侧穿支皮瓣(面积为12.5 cm×5.0 cm~25.0 cm×15.5 cm),并对皮瓣进行修薄处理后修复手部皮肤软组织缺损。将供区创面直接缝合或取对侧大腿中厚皮片移植修复。根据需要,于Ⅰ期术后每隔约3个月行1次或多次分指+指蹼成形术,对皮瓣进行整复。Ⅰ期术后,观察皮瓣成活、并发症发生情况,供区创面愈合情况。随访时,观测皮瓣外观、两点辨别觉距离及手部功能等情况。末次随访时,根据中华医学会手外科学会上肢部分功能评定试用标准对患手功能进行评定。结果Ⅰ期术后,15例患者皮瓣均完全成活,其中1例患者皮瓣出现动脉危象,经探查并重新吻合血管后完全成活;供区创面全部愈合。Ⅰ期术后随访6~18个月,皮瓣外形稍臃肿,有少许色素沉着,两点辨别觉距离为8~11 mm;手指可完成屈、伸、捏、握等基本生活动作。末次随访时,患手功能评定为优者3例、良者9例、可者3例。结论针对全手脱套毁损性创面,Ⅰ期采用游离移植一侧或双侧修薄的股前外侧穿支皮瓣进行修复,后期采用分指+指蹼成形术对皮瓣进行整复,可基本恢复患手生活所需的捏握功能,值得临床推广。ObjectiveTo investigate the effects of thinned anterolateral thigh perforator flaps combined with finger splitting and webplasty in sequential treatment of degloving destructive wound of total hand.MethodsThis study was a retrospective observational study.From January 2012 to January 2023,a total of 15 cases who met the inclusion criteria with degloving destructive wound of total hand were admitted to Ningbo No.6 Hospital,including 10 males and 5 females,aged 17-75 years.The wounds were all combined with exposed bones or tendon.Emergency debridement and vacuum sealing drainage were performed in all cases before flap transplantation in stageⅠ.After thorough debridement,the wound area was 11.0 cm×3.0 cm-23.0 cm×13.5 cm.One or both anterolateral thigh perforator flaps with size of 12.5 cm×5.0 cm-25.0 cm×15.5 cm were designed,cut,and thinned to repair the skin and soft tissue defects of the hand.The donor site was sutured directly or repaired with medium-thickness skin graft from the opposite thigh.As needed,the flap was reconstructed by finger splitting and webplasty once or more times every 3 months after stageⅠoperation.The survival and complications of flap and wound healing at the donor site were observed after stageⅠoperation.The appearance of flap,two-point discrimination distance,and hand function were observed during the follow-up.At the final follow-up,the function of the affected hand was evaluated by the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association.ResultsAfter the operation of stageⅠ,all the flaps of 15 cases of patients survived completely,including 1 case that had arterial crisis of flap but survived completely after exploration and re-anastomosis of blood vessels;all the wounds at the donor site healed.During the follow-up period of 6 to 18 months after stageⅠ,the flap was slightly swollen,with a little pigmentation,and the two-point discrimination distance in the finger flap was 8-11 mm.The fingers could

关 键 词：手 脱套伤 外科皮瓣 显微外科手术 创面修复 

分 类 号：R658.2[医药卫生—外科学]